Massachusetts Health Coverage High but Cost and Access Challenges Persist

Massachusetts maintains a low uninsured rate at 2.1%, well below the national average of 8.2%, according to the latest Massachusetts Health Insurance Survey. The survey, conducted by the Center for Health Information and Analysis (CHIA), highlights high continuous coverage rates, with nine out of ten residents reporting insurance for all household members over the past year. Despite broad coverage, affordability remains a significant barrier, with approximately 28% of residents delaying or foregoing care due to costs, largely driven by the prevalence of high-deductible health plans. Nearly half of the commercially insured population holds such plans, characterized by deductibles of $1,650 or more for individuals and $3,300 for families, contributing to substantial out-of-pocket expenses. Medical debt persists even among insured residents; about 90% of those with medical debt incurred it despite having coverage. Deductibles and cost-sharing mechanisms like copays and coinsurance are prominent contributors to this debt. However, individuals below 139% of the federal poverty level report lower medical debt levels, likely due to MassHealth and ConnectorCare eliminating many copays and cost-sharing requirements. Administrative challenges also affect access to care, with one in five residents encountering issues such as billing disputes, difficulties obtaining coverage information, and prior authorization delays. While a majority of residents have primary care providers, disparities exist among racial groups, and nearly 30% report challenges accessing primary care appointments timely. Behavioral health needs remain partially unmet; over 10% report unmet behavioral health needs, with costs cited as a barrier by some. Additionally, nearly a quarter of residents visited emergency departments, with about one-third of these visits considered avoidable with better access to non-emergency care. Looking ahead, policy discussions at the state level focus on addressing coverage disruptions anticipated from federal Medicaid changes and considering legislation aimed at strengthening primary care access. These findings underline the ongoing challenges in balancing broad insurance coverage with actual access and affordability of health care in Massachusetts.